HomeMy WebLinkAboutMeyer, Karen DS-DE 9 - Updated 2024 08 22.pdfAPPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
RECEIVED
(Section 106.021(1), F.S.)
AUG 2 r2 2024
(PLEASE PRINT OR TYPE)
CITY OF WINTER SPRINGS
NOTE: This form must be on file with the filing officer before
OFFICE OF THE CITY CLERK
opening the campaign account.
OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
❑ Initial Filing of Form W Re -filing to Change: ❑ Treasurer/Deputy N Depository ❑ Office ❑ Party
2. Name of Candidate (in this order: First, Middle, Last):
3. Address (include PO Box or Street, City, State, Zip Code):
(Please Print or Type Name)
kAi?j5 V 4A) A✓ ME \Y16R
y► O M P S'R ING-S� �rG 3�2 70C
4. Telephone:
5. Candidate's Voter Registration #:
6. Email Address:
( �I LI - �3,� �
/< 21�r kl o l&ff
/t wyw or k/9 r4 Cr CJ44IA911� . mom
(not required for qualifying purposes)
7. Office Sought (include district, circuit, group, or seat #):
8. If a candidate for a nonpartisan office, check the box
if applicable:
Wj1V7j'/2 SPRIAI&S CLO#1M /SSiDN, 5)6 fI-3
❑ 1 intend to run as a Write -In Candidate.
9. If a candidate for partisan office, check the box and fill in the name of the party as applicable: I intend to run as a
❑ Write -In Candidate. ❑ No Party Affiliation Candidate. ❑ Party candidate.
10. 1 have appointed the following person to act as my: ® Campaign Treasurer ❑ Deputy Treasurer
11. Name of Treasurer or Deputy Treasurer:
12. Telephone:
13. Email Address:
AWM 4119AW Meyjil'
( iy ) 96� --4 3,?1
i�t�yE 6YPR4• oru
14. Mailing Address:
15. City:
16. State:
17. Zip Code:
7411 Aivpe)11i5l? 61AC4
WlN1 �n-s'/ppYNC,S
18. 1 have designated the following bank as my (check appropriate box): ❑ Primary Depository ❑ Secondary Depository
19. Name of Bank:
20. Address:
VJi5US FA2GD 13ANK A R.
5&L90 %*b PUG L4e� ► 19AQ
21. City:
22. County:
23. State:
24. Zip Code:
0IN745R 05"P/2/NGs
SEMIA)PL&
.3Q7P9
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR THE APPOINTMENT OF THE
CAMPAIGN TREASURER AND DESIGNATION OF THE CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE,
26. Signature of Candidate:
25. Date: 0 -aa —Owl A/
X A �
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate box)
AAqrk� A14)A/P do hereby designated
I, accept the appointment above as:
(Please Print or Type Name)
® Campaign Treasurer. ❑ Deputy Treasurer.
29. Signature of Campaign Treasurer or Deputy Treasurer
28, Date:
DS-DE 9 (Rev. 09/23) Rule 1S-2.0001, F.A.C.